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Chlamydia trachomatis and risk of cervical intraepithelial neoplasia grade 3 or worse in women with persistent human papillomavirus infection: a cohort study
  1. Kirsten E Jensen1,
  2. Louise T Thomsen1,
  3. Sven Schmiedel2,
  4. Kirsten Frederiksen2,
  5. Bodil Norrild3,
  6. Adriaan van den Brule4,
  7. Thomas Iftner5,
  8. Susanne K Kjær1,6
  1. 1Unit of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
  2. 2Unit of Statistics, Bioinformatics and Registries, Danish Cancer Society Research Center, Copenhagen, Denmark
  3. 3Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
  4. 4Laboratory for Molecular Diagnostics, Department of Medical Microbiology and Pathology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
  5. 5Medical Virology, Section of Experimental Virology, University Hospital of Tübingen, Tübingen, Germany
  6. 6Gynecologic Clinic, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
  1. Correspondence to Professor Susanne K Kjær, Unit of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen DK-2100, Denmark; susanne{at}cancer.dk

Abstract

Objectives Some studies suggest that Chlamydia trachomatis (CT) enhances cervical carcinogenesis; however, a possible confounding effect of persistent human papillomavirus (HPV) infection was not addressed. We examined the potential role of CT infection in the development of subsequent cervical intraepithelial neoplasia grade 3 or worse (CIN3+) in women with prevalent HPV infection and in a subgroup of women with persistent HPV infection.

Methods Participants in this population-based cohort study underwent a structured interview, including history of CT infection, and subsequently cervical exfoliated cells were obtained for HPV DNA and CT DNA testing. Women with high-risk HPV DNA infection and no prevalent cervical disease constituted the overall study population (n=1390). A subgroup of women with persistent HPV infection (n=320) was also identified. All women were passively followed for development of cervical lesions in the national Pathology Data Bank. HRs and 95% CIs for CIN3+ during follow-up (up to 19 years) were estimated in an accelerated failure time model.

Results Women who reported more than one CT infection had a statistically significantly increased risk of CIN3+ (high-risk HPV-positive, HR=2.51, 95% CI 1.44 to 4.37) (persistent HPV infection, HR=3.65, 95% CI 1.53 to 8.70). We found no association between CT DNA and subsequent risk of CIN3+ among women who were HPV-positive or had a persistent HPV infection at baseline.

Conclusions Repeated CT infections increased the risk of CIN3+ among women with prevalent as well as persistent high-risk HPV infection.

  • Chlamydia Trachomatis
  • HPV
  • Cervical Neoplasia

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